Trust-Based Relational Intervention (TBRI

1 Trust-Based Relational Intervention (TBRI ). Presented by: Black Hills Seminar S TA Y C A L M ( N O M AT T E R W H AT ). S E E T H E N E E D ( B E H I N D T H E B E H AV I O R ). M E E T T H E N E E D ( F I N D A W AY ). D O N ' T Q U I T ( I F N O T YO U , T H E N W H O ? ). T R U S T- B A S E D R E L AT I O N A L I N T E R V E N T I O N. TBRI. K A RY N P U RV I S I N S T I T U T E O F C H I L D D E V E L O P M E N T. Copyright 2017 Karyn Purvis Institute of Child Development All Rights Reserved Contents Trauma and Traumawise Care 9. Trust-Based Relational Intervention 13. Creating Healing Connections 15. Empowering Our Kids to Succeed 19. Shaping Our Kids' Behavior 21. Bibliography 25. 7. Introduction This notebook was created to serve participants attending the work- shop offered by Dr.

2 David Cross on Interpersonal Trauma and Trust- Based Relational Intervention (TBRI ), delivered in Rapid City at Black Hills Seminars, hosted by CF Learning on July 30th, 2017. Trauma and Traumawise Care Interpersonal Trauma (Victimization). Interpersonal trauma (victimization) is a complex phenomenon that 1. D'Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., and van der Kolk, B. A. impacts children youth in complex We summarize the impact (2012). Understanding interpersonal of interpersonal trauma on children's brains in our two diagrams, trauma in children: Why we need a Theater of the Mind (Figure 1) and Levels of Felt Safety (Fig- developmentally appropriate trauma diagnosis. American Journal of Orthopsy- ure 6). Both diagrams are based on Bessel van der Kolk's The Body chiatry, 82(2):187 200.

3 Keeps the 2. van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking, New York 10 tbri Trauma and the Brain Mindful Contextual Somatic Awareness Awareness Awareness Mohawk of Watchtower Timekeeper . Self-Awareness . Cortical areas Cingulate are de-activated MPFC DLPFC OPFC/MPFC. by trauma Insula Cook Smoke Detector . Sensory Input Amygdala is Thalamus Amygdala hyper-activated by trauma Plumber Electrician . Hypothalamus Brainstem PNS:VVC See HPA Axis SNS Levels of (Cortisol). PNS:DVC Felt-Safety Figure 1: This Theater of the Mind . helps summarize and visualize the most important ways that trauma impacts processing in the brain and the periph- eral nervous systems. Van der Kolk (2014) provided most of the nicknames ( , Timekeeper ), but we added two of our own: Plumber and Elec- trician.

4 MPFC = Medial Prefrontal Cortex; DLPFC = Dorsilateral Prefrontal Cortex; OPFC = Orbital Prefrontal Cortex; HPA = Hypothalamic-Pituitary- Adrenal. trauma and traumawise care 11. Safe Havens and the Brain Feels Safe VVC Calm/Explore Perceived Threat VVC Seek Safe Haven No Haven/Immediate Danger SNS Fight or Flight No Escape/Immediate Danger DVC Freeze/Collapse Figure 2: This Levels of Felt-Safety . diagram summarizes how various situa- tions are processed by child and youth, based on recent work on the polvagal system see The Body Keeps the Score. VVC = Ventral Vagal Complex (the Smart Vagus ); SNS = Sympathetic Nervous System; DVC = Dorsal Vagal Complex (the primitive vagus). 12 tbri Three Pillars of Traumawise Care and Service TBRI was designed to meet the most pressing needs of children and adolescents who come from hard places their needs correspond to the Three Pillars of Traumawise Care (see Figure 3).

5 3. Figure 3: Three Pillars of Traumawise Care provide a useful framework for conceptualizing and creating inter- ventions for children and youth who Self-Regulation have experienced interpersonal trauma. Connection Felt-Safety Connection is the central pillar be- cause both felt-safety and the ability to self-regulate depend on healthy connec- tions. One of the lessons of attachment theory and research is that felt-safety in children and youth is based on access to a safe and accessible caregiver (see Figure 6). Self-regulation develops in the context of safe and comforting parent-child interactions: First there is Other-Regulation, then there is Co-Regulation, and then there is Self-Regulation.. 3. Bath, H. (2008). The three pillars of trauma-informed care.

6 Reclaiming Chil- dren and Youth, 17(3):17 21; and Bath, H. (2015). The pillars of traumawise care: Healing in the other 23 hours. Reclaiming Children and Youth, 23(4):5 11. Video: Still-Face Trust-Based Relational Intervention TBRI is based on the sensible idea that effective interventions must focus on the whole child their behaviors, emotions, thoughts, rela- tionships, ecologies, and physiology (see Figure 4).4. Figure 4: Trust-Based Relational Intervention (TBRI ) can be di- CORRECTING vided into three sets of principles: The Connecting Principles are based on Proactive Responsive attachment theory, and include Mind- ful Awareness and the Engagement Strategies Strategies Strategies. The Empowering Princi- ples help provide a stable platform Mindful for Connecting and Correcting, and include the Ecological Strategies and Awareness the Physiological Strategies.

7 The Cor- recting Principles are designed to help CONNECTING adults shape behaviors and skills, and include the Proactive Strategies and the Engagement Responsive Strategies. TBRI is effective Strategies because these principles and strategies impact the child synergistically to create healing and well-being. Ecological Physiological Strategies Strategies 4. Diamond, A. (2010). The evidence base for improving school outcomes EMPOWERING. by addressing the whole child and by addressing skills and attitudes, not just content. Early Education and De- velopment, 21(5):780 793; and Purvis, K. B., Cross, D. R., Dansereau, D. F., and Parris, S. R. (2013). Trust-Based re- lational Intervention (TBRI): a systemic approach to complex developmen- tal trauma. Child & Youth Services, 34(4):360 386.

8 Video: Attachment Ritual Creating Healing Connections In this part of the workshop, we focus on the Connecting Principles, which are the heart and soul of TBRI (see Figure 4). Mindful Awareness As can be seen in Figure 4, Mindful Awareness is the core capacity for the practice of TBRI; in order to better understand this elusive construct, we list some benefits of mindful awareness:5 5. Siegel, D. J. (2009). Mindful awareness, mindsight , and neural integration. The fear extinction and modulation; Humanistic Psychologist, 37(2):137 158. attuned communication;. response flexibility;. empathy and morality;. emotional balance;. intuition and insight;. regulation of bodily processes. 16 tbri Engagement Strategies The TBRI Engagement Strategies reflect the importance of nonverbal communication6 , and could be considered the face of mindful 6.

9 Mehrabian, A. (2007). Nonverbal communication. Aldine Transaction, awareness; the Engagement Strategies include:7. Chicago, IL. 7. Purvis, K. B., Cross, D. R., and Lyons- authoritative voice (tone, volume, cadence), Sunshine, W. (2007). The connected child: Bring hope and healing to your adoptive valuing eye contact, family. McGraw-Hill, New York behavioral matching, playful interaction, appropriate touch. creating healing connections 17. Nurture Groups and the Four Skills A core TBRI activity is the Nurture Group Nurture Groups are de- signed to teach the Four Skills of Close 8. Cassidy, J. (2001). Truth, lies, and intimacy: An attachment perspective. Attachment and Human Development, Nurture Group principles and practices: 3(2):121 155. Three rules: Stick together, no hurts, have fun!

10 9 9. Rubin, P. B. and Tregay, J. (1989). Play with them Theraplay groups in the Core activities: Feeding and band-aids classroom: A technique for professionals who work with children. Charles C. Life Skill activities ( , practice respect with role play) Thomas, Springfield, IL. Self-Regulation activities ( , Engine Check, Silly String ). The Four Skills of Close Relationships Be able to give care Be able to receive care Be able to negotiate your needs ( , choices, compromises). Be capable of autonomy Autonomy within relationship, relationship within autonomy . Videos: Nurture Groups Empowering Our Kids to Succeed In this part of the training, we focus on the Empowering Principles, which provide a foundation for effective Connecting and Correcting (see Figure 4).